Arizona and New Jersey Award Fee Schedule Engagements to FAIR Health

October 20, 2022

As a result of competitive bidding processes, Arizona and New Jersey have each awarded a fee schedule engagement to FAIR Health. In Arizona, FAIR Health is assisting the state in updating its workers’ compensation fee schedule for professional services. In New Jersey, FAIR Health is helping the state update its auto personal injury protection (PIP) fee schedules.

Working with the Industrial Commission of Arizona, FAIR Health will assist the state in updating the 2023 Arizona Physicians’ Fee Schedule (effective in October 2023) and reviewing the potential to use FAIR Health data to gap-fill codes not covered by Medicare.

In New Jersey, working with the Department of Banking and Insurance, FAIR Health is assisting in updating the state’s PIP medical fee schedules, which govern payments for healthcare services and equipment for personal injuries related to automobile accidents.

FAIR Health has a history of engagement in both states. In Arizona, FAIR Health data are already licensed by the state to support the reimbursement of dental claims for disabled pediatric patients. In New Jersey, the state’s automobile and PIP insurance regulations require that medical services not covered in the state’s fee schedule may not exceed the “usual, customary and reasonable fee” for the service. The regulations identify the FAIR Health database as a national database of fees that are evidence of the reasonableness of fees for the provider’s geographic region or zip code.

The new engagements in Arizona and New Jersey continue an ongoing tradition of FAIR Health service to states. FAIR Health has supported workers’ compensation programs in Colorado, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina and Tennessee. FAIR Health is supporting Michigan PIP by gap-filling codes not valued by Medicare. In addition, FAIR Health benchmarks are used by parties in several other states for auto liability and to support the resolution of disputes.

FAIR Health data also are used or officially approved by states for a number of other purposes, including serving as a basis for reimbursement under surprise billing legislation in various jurisdictions. For example, FAIR Health data serve as the independent, official data source for surprise billing laws in Connecticut, Georgia, New Mexico, New York and Texas. FAIR Health provides a broad range of other assistance to states, including supplying benchmarks that serve as standards for payment under various laws and regulations, such as programs established to support medical services for crime victims, as well as programs that offer reimbursement to providers for the provision of certain “wellness” services in Washington State.

FAIR Health President Robin Gelburd stated: “We are delighted to put our data and expertise to work to help additional states keep their fee schedules current. As our state client list grows, we are especially gratified that our current clients have publicly shared their positive experiences working with the FAIR Health team. Supporting states in this important work is an essential part of our mission.”

For more information about the wide range of services and data products FAIR Health offers state health programs and initiatives, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.